It is the final method when all the other methods fail to
control post partum haemorrhage
It includes two steps,
•a. Ligation of uterine arteries
•b. Ligation of ovarian and ut. artery anastomosis
•c. Ligation of ant. div. of int. iliac artery
•d. B- Lynch compression suture and multiple
•e. Angiographic arterial embolisation
1. Devascularisation procedure :
A. Ligation of ut. arteries;
Ascending branch of uterine artery ligated b/n
upper and lower uterine segment.
No.1. chromic catgut is used.
If bleeding continues.
B. Ligation of ovarian & uterine artery anastamosis:
Done just below the
ovarian ligament. Some times, temporary
occlusion of ovarian vessels at
infundibulopelvic ligament is
done by rubber sleeved clamps.
Ligation of uterine artery and utero-ovarian artery
C. Ligation of anterior division of internal iliac artery.
Done unilaterally or
Bilateral ligation avoids
hysterectomy in 50% of
D. B-Lynch compression sutures &
multiple square sutures
Developed by Christopher B-Lynch.
Used to mechanically compress an atonic uterus in the face of
Success rate is about 80% and can avoid hysterectomy.
E. Angiographic arterial embolisation.
Done to bleeding vessel under
Gel foam is used as embolus.
Success rate >90% & it avoids
of patient in ICU/ high
After this procedure, if
bleeding is controlled,
2.Hysterectomy – Final most step.
Only if uterus fails to
contract & bleeding
If mother is parous,
decision is taken earlier.
It may be total or subtotal
depending on the case.
done under good
For traumatic PPH